New airplane guidelines for diabetics and syringes

Ulysses Torassa

Published 4:00 am, Sunday, October 21, 2001

They're often right up there on the list with guns, knives and box cutters: No syringes allowed in carry-on luggage. Which would seem to make sense - unless you're a diabetic who can't get through a long flight without an injection of insulin.

There's been a lot of confusion in the past month about syringes and the Federal Aviation Administration's strict new rules on carry-on luggage. Last week, though, the FAA issued guidelines that should clear things up, at least for now.

More than 11 million people in the United States have diabetes, a number that is growing rapidly. About 5 million of those need to take insulin injections to keep a stable level of sugar in their blood. Diabetics also use small lancets to prick their fingers and check their blood sugar levels.

Diabetics have long been advised not to pack their insulin supplies in their checked luggage, because they may need them during the flight. There are also fears the life-critical drugs could be lost in checked luggage.

Since the new anti-terrorism regulations went into effect, various airlines have taken different approaches to dealing with diabetic syringes - from requiring prescription forms and medical ID bracelets to requiring diabetics to give their needles to flight attendants, who safeguard them until they're needed.

Under the new FAA guidelines, passengers can board with syringes (or other insulin delivery systems) as long as they have a vial of insulin with a professional, pharmaceutical pre-printed label identifying the medication and the patient's name.

(Since the prescription label is often on the box containing the insulin vial, the agency advises diabetics not to discard the box, but to bring it with them to the airport.)

Diabetics can bring aboard lancets to test blood sugar, as long as they are capped and accompanied by a glucose monitor with the manufacturer's name embossed on it.

What are not acceptable are prescriptions or letters of medical necessity, out of concerns they could be easily forged.

The American Diabetes Association also recommends that people traveling with glucagon (an injectable hormone that acts to raise blood sugar in emergencies) keep their kit in its original pre-printed, pharmacy-labelled container.

ADA spokesman Jerry Franz said he doesn't think the new FAA regulations will pose a serious problem.

"It's inconvenient, but we think it's an inconvenience that people with diabetes are willing to put up with knowing that all Americans are dealing with tighter security," he said.

At the same time, Franz said it is still worth checking with the airline the day before flying, since carriers may impose stricter rules on their own. And new security threats can always trump the current guidelines.

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Economy class syndrome: The events of Sept. 11 overshadowed a New England Journal of Medicine study that would otherwise have gotten widespread press attention.

In the Sept. 13 issue, French researchers reported that people getting off long-distance flights had a significantly higher risk for pulmonary embolisms than those disembarking from short trips.

We wrote extensively about the issue of deep vein thrombosis - also known as "economy class syndrome," or "traveler's thrombosis" - in June, and at the time it was becoming clear that blood clots from sitting in a cramped space for long periods was becoming recognized as a risk for long-distance air travelers.

When clots lodge in the pulmonary artery they can shut off the body's oxygen supply and cause sudden death.

The researchers reviewed 56 reports of pulmonary embolisms among people arriving at Charles de Gaulle Airport outside Paris from 1993 through 2000. While the overall risk remains small, they found that it was 150 times higher for people traveling more than 3,100 miles compared with those on shorter trips (1.5 cases per million versus .01 case per million). For those flying more than 6,200 miles, the risk shot up to 4.8 cases per million.

In an accompanying editorial, Dr. Jack E. Ansell of Boston University Medical Center said the findings represent "the tip of the iceberg," since the researchers only focused on people who had symptoms of pulmonary embolism - the most serious complication of deep vein thrombosis - within an hour after getting off the flight.

Strategies for preventing traveler's thrombosis include wearing loose clothes, drinking plenty of fluids, abstaining from alcohol and getting up and walking around frequently - or at least stretching your legs and flexing your feet at your seat. Some researchers have also suggested the use of low-dose aspirin before long trips, but this remains controversial.

Thrombosis can strike anyone, but factors that increase the risk include obesity, pregnancy, chronic heart disease, use of hormone medications, malignancies, history of blood clots, varicose veins and recent trauma or surgery.

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